It’s not just about the pen!
Should I continue to use drug reps as my primary source of information about new drugs?
Dr Brett Montgomery has written on the subject here https://theconversation.com/why-i-dont-see-drug-reps-a-gps-take-on-big-pharma-spruiking-32435
And it’s not just doctors that they target, nurses are also seen as a way into the prescribing sphere of influence. https://theconversation.com/invisible-influence-why-sales-reps-are-forming-relationships-with-nurses-57061
Here is the New Zealand perspective https://theconversation.com/drug-ads-only-help-big-pharmas-bottom-line-so-why-are-they-allowed-45317
As this paper entitled Following the Script: How Drug Reps Make Friends and Influence Doctors from a few years ago suggests
“Reps may be genuinely friendly, but they are not genuine friends. Drug reps are selected for their presentability and outgoing natures, and are trained to be observant, personable, and helpful.”
Dr Ben Goldacre has blogged on his BadScience website and written on the influence of pharmaceutical companies on drug utilisation. After eventually making it through his book, Bad Pharma I felt a very pessimistic about the whole process. It’s a bit like House of God, essential junior doctor reading.
A list of problems include
- Missing clinical data which the rep probably doesn’t know about either
- Positive paper publication bias
- Ghost writers instead of academics
- No decent independent head to head studies, so what if me2 is better than placebo is it better than the first drug?
- Kick backs to medical journals
- Half blind public agencies
- Statistical manipulations and sub-subgroups analysis
- Glossed over serious adverse effects. “The risk of thyroid cancer with Saxenda is over rated!” or “No that only happens in beagles”
- Glossy brochures and advertising in journals.
- Pushy drug reps and their inducements – which do seem limited to lunch rather than international flights these days.
- Leaving behind drug samples as starter packs
- Subsidising patients support groups and turning them into pharmaceutical lobby groups
- Product familiarisation campaigns
- Breaking news on popular media dressed up as “news” stories
- Chatting in the ear of the clinic nurses, who also look after the sample cupboard. I wonder if any rep has suggested that the oppositions product be pushed to the back or even in the bin?
- Paying specialists to “educate” GPs
- Creating a “disease” to sell a product, eg fibanserin for a woman’s poor libido
As a health professional am I impervious to drug rep propaganda? I think the evidence suggests NO.
A few hints include the average sales force expenditure for pharmaceutical companies is $875 million annually and that is just in the USA. Being Australian, I am of course more skeptical and cynical but even so it has been estimated that in 2012, $30 million was spent by pharmaceutical companies trying to persuade doctors to use their product. I think it safe to assume no one would spend that kind of money if there wasn’t some return.
So where to find unbiased information?
National Prescribing Service would be a good place to start in Australia.
This paper by Richard O Day and Leone Snowden details other useful sources of drug information.
I have also listened to this podcast about conflict of interest. Sam Manger talks about how we may be able to immunise ourselves against drug rep influence.
I think these are pretty good reasons why we have decided drug reps don’t visit the clinic I work in.